Events & Resources

GNYGCC LVAD/Frailty Study

The consortium is investigating Frailty measures in LVAD candidates to determine if LVAD placement reduces frailty.

click here for study description

Category: News

Click Events and Resources Below for Past Seminars

Listed in reverse order, they include all slides, readings, tests and more.

Decision Making and End of Life Care

Dr Hannah I. Lipman, Bioethicist, Geriatrician and Cardiologist; Einstein/Montefiore addressed the challenges of Decision Making and End of Life care. She is Associate Director of the Center for Bioethics, Chief – Bioethics Consult Service and Assistant Professor of Medicine in both divisions of Geriatrics and Cardiology at Albert Einstein College of Medicine and Montefiore Medical Center.

Take the Pre-Test Here:

Pre-Test

See the Presentation Here:

Decision Making and End of Life Care

Take the Post-Test Here:

Post-Test

Access the Slideset Here:

Decision Making and End of Life Care

Suggested Reading:

Assessment of patients’ competence to consent to treatment — Appelbaum PS.

Clinical Practice — Palliative Care by Morrison RS, Meier DE.

Communication and decision-making about prognosis in heart failure care — Goodlin SJ, Quill TE, Arnold RM.

Do-not-resuscitate order after 25 years — Jeffrey P. Burns, MD, MPH; Jeffrey Edwards, MA; Judith Johnson, JD; Ned H. Cassem, MD; Robert D. Truog, MD

Palliative care in the treatment of advanced heart failure — Adler ED, Goldfinger JZ, Kalman J, Park ME, Meier DE.

HRS Expert Consensus Statement on the Management of CIEDs in patients nearing end of life or requesting withdrawal of therapy

Learning Objectives:

• List the elements of informed consent and decision-making capacity.
• Identify types of advance directives and understand the role of patients’ values, preferences, and goals in decision making.
• Understand issues around DNR orders in different care settings.
• Recognize that palliative care and hospice benefit patients and families by addressing multiple dimensions of suffering.
• Identify key components of care for imminently dying patients and their families.

Perioperative Care of the Elderly

Dr. Beth Barron — On the special perioperative needs of the older patient.  Dr Barron is Assistant Clinical Professor at Columbia University’s College of Physicians and Surgeons, as well as Assistant Program Director of the Internal Medicine residency.  She works at NYP’s Allen Hospital, where she is also Co-Director of the Hospitalist Program

Take the Pre-Test Here:

Pre-Test

See the Presentation Here:

Heart Rhythm Disorders in Older Adults

Take the Post-Test Here:

Post-Test

Access the Slideshow Here:

Perioperative Care of the Elderly

Suggested Reading:

Priorities in Perioperative Geriatrics – Cook, DJ,

Reducing delirium after hip fracture – a randomized trial. Marcantonio ER

Frailty as a Predictor of Surgical Outcomes in Older Patients — Makary

Perioperative Care of the Elderly Patient – An update — Palmer, RM

Learning Objectives:

1. Review the effects of aging on organ systems and consider how this affects the perioperative evaluation

2. Consider interventions to predict and reduce complications

3. Review the approach to perioperative evaluation in the elderly

Heart Rhythm Disorders in Older Adults

Dr Michael Rich, Washington University School of Medicine, Professor; Barnes-Jewish Hospital, Director: Cardiac Rapid Evaluation Unit.

Take the Pre-Test Here:

Pre-Test

See the Presentation Here:

Heart Rhythm Disorders in Older Adults

Take the Post-Test Here:

Post-Test

Access the Slideshow Here:

Heart Rhythm Disorders in Older Adults

Suggested Reading:

Meta-Analysis: Age and Effectiveness of Prophylactic Implantable Cardioverter-Defibrillators, Annals of Internal Medicine, 2012

Atrial Fibrillation- an Epidemic in the Elderly, Expert Reviews in Cardiovascular Therapy 2011

New Insights Into Pacemaker Activity – Promoting Understanding of Sick Sinus Syndrome, Circulation 2007

Syncope and Hypotension in the Elderly Patient

Dr. Lew Lipsitz
Director and Professor, Dept of Aging, Harvard Medical; Chief, Gerontology, Beth Israel Deaconess Medical Center; Director and Senior Scientist, Institute for Aging Research — spoke on Syncope and Hypotension in the Elderly Patient.

Take the Pre-Test Here:

Pre-Test

See the Presentation Here:

Link to Presentation

Take the Post-Test Here:

Post-Test

Access the Complete Slideset Here:

Syncope and Hypotension in the Elderly Patient

Suggested Reading:

NIH Clinical Guidelines for Transient Loss of Conciousness;
Cooper et al; Annals of Internal Medicine; 2011.

Predicting Adverse Outcomes in Syncope;
Grossman, Lipsitz et al; Journal of Emergency Medicine; 2007.

Orthostatic Hypotension in the Elderly: Diagnosis and Treatment;
Gupta, Lipsitz; American Journal of Medicine; 2007.

Learning Objectives:

1) To understand the effects of aging on blood pressure regulatory mechanisms and how age-related changes in these mechanisms can lead to hypotension and syncope in older people.

2) To recognize that hypertension also impairs blood pressure regulation, further increasing the risk of hypotension and syncope in elderly hypertensive people.

3) To appreciate what is different about syncope in the elderly patient.

4) To tailor the evaluation of syncope to identify the most common causes in elderly patients.

5) To understand that orthostatic and postprandial hypotension are common causes of syncope in elderly people and to become familiar with their etiology and treatment.

6) To identify opportunities for future research on the topics of syncope and hypotension in elderly people.

Heart Failure in Older Adults

Dr Mat Maurer Associate Professor, Cardiology; Medical Director, CCRLE – Columbia University.

Take the Pre-Test Here:

Pre-Test

See the Presentation Here:

Link to Presentation

Take the Post-Test Here:

Post-Test

Suggested Reading:

Global Cardiovascular Reserve Dysfunction in Heart Failure With Preserved Ejection Fraction

Heart Failure with Preserved Ejection Fraction – Persistent Diagnosis, Therapeutic Enigma

Left Heart Failure With a Normal Ejection Fraction – Identification of Different Pathophysiologic Mechanisms

Transthyretin Cardiac Amyloidoses in Older North Americans

Diastolic Dysfunction – Can it Be Diagnosed With Doppler Echocardiography ?

Learning Objectives:
1. Delineate at least 3 core principles of geriatric medicine.‬‬
2. ‪Illustrate how these principles can be applied to the physiologic understanding, evaluation and management of older adults with heart failure.‬‬
3. ‪Understand why the “classic” pathophysiologic explanation (diastolic dysfunction) is not adequate to explain all cases of HFPEF.‬‬
4. ‪Identify novel extra-cardiac targets that are therapeutic targets for older adult patients with heart failure, particularly with HFPEF‬‬.

Prevention and Risk Factors for CVD in the Older Adult

In, “Prevention in the Older Adult: Good Clinical Care or Oxymoron?“, Dr Dan Forman, argued that we must do more to meet the challenges of care for older adults and that there are definite gains to be had in outcomes via prevention – at virtually any age…

Chair of the ACC’s Council for the Care of Older Adults and professor of medicine at Brigham Womens/Harvard Medical School, Dr Forman presented on Risk Factors and Prevention in Older Adults with Cardiovascular disease.

See the Presentation Here:

Link to Presentation

Take the Pre-Test Here:

Pre-Test

Take the Post-Test Here:

Post-Test

Access the Complete Slideset Here:

Prevention in the Older Adult: Good Clinical Care or OXYMORON?

Suggested Reading:

Cardiac Care for Older Adults -Time for a New Paradigm
Cardiac Rehabilitation and Survival in Older Coronary Patients
Use of Cardiac Rehabilitation by Medicare Beneficiaries after Myocardial Infarction and Coronary Bypass Surgery
Effects of Physical Activity on Cardiovascular and Noncardiovascular Outcomes in Older Adults
Cardiac Rehabilitation for Women across the Lifespan
Cardiac Rehabilitation for Elderly Cardiac Patients -CHAPTER

Learning Objectives:
• Understand the relevance of exercise capacity and the value of exercise training on optimizing health and function.
• Recognize the importance of preventive CV care for older adults.
• Understand the relationship between risk factors and CVD across the human lifespan.
• To demonstrate the need for an improved strategy for exercise mode and intensity. To clarify need for improved exercise training endpoints. To clarify need for improved risk prediction among older adults.

CAD and Acute MI in Older Adults

Dr Karen Alexander led the GNYGCC seminar to discuss Acute MI and CAD in older adults.  Dr Alexander is associate professor of medicine in cardiology at Duke University and co-authored the AHA statement on care of acute MI in the elderly.

See the Presentation Here:

Presentation

Take the Pre-Test Here:

Pre-Test

Take the Post-Test Here:

Post-Test

Access the Complete Slideset Here:

Acute MI in Older Adults:Slides

Suggested Reading:

AHA Guidelines Acute MI Part 1
AHA Guidelines Acute MI Part 2
Cardiac Care for Older Adults: Time for a New Paradigm

Learning Objectives:

  • Recognize presentation of myocardial ischemia in older adults.
  • Understand safe and effective therapies for ACS in older adults.
  • Assess the likely health outcomes among older adults with ACS
  • Appreciate the role of discharge planning in optimizing medication safety and return to independent functioning.
  • Enumerate unmet needs in the area that are ripe for multi-center collaboration.

Chronic Coronary Disease in Older Adults – You CAN treat angina!

Dr Joseph Tenenbaum, discussed the diagnosis and care of stable Angina in older adults.

Chronic Coronary Disease in Older Adults – You CAN treat angina!

Dr Tenenbaum is Chief of Medicine Service at Allen Hospital/NYP and Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

SEE THE COMPLETE PRESENTATION HERE

TAKE THE PRE-TEST HERE

TAKE THE POST-TEST HERE

See the slide set below (in two parts).

Geriatric Cardiology – You CAN treat Angina! Part 1

Geriatric Cardiology – You CAN treat Angina! Part 2

Suggested Reading:

Focused Update of the ACC-AHA 2002 Guidelines for the Management of Patients with Chronic Stable Angina, J Am Coll Cardiol 2007; 50:2264-2274

The Cardiovascular Health, Study J Am Geriatr Soc 52:1639–1647, 2004

Treating to New Targets, N Engl J Med 2005; 352:1425

STS Database for CABG Only outcomes in the elderly, J Am Coll Surg 2003; 197:347-357

COURAGE Trial, N Engl J Med 2007; 356: 1503-16.

TIME Trial, JAMA 2003; 289: 1117

Ranolazine for the Treatment of Angina, CIRCULATION 2006; 113: 2462

Learning Objectives:

–Recognize differences in epidemiology and disease presentation of chronic coronary disease in older adults compared to younger adults.

–Consider issues related to medical management and safe revascularization of chronic CAD in older adults with a focus on:

* Management of multiple comorbidities.
* Role of collaborative care models.
* Risk of polypharmacy and management strategies
* Use of drug eluting versus bare metal stents for revascularization
* Efficacy of standard and emerging therapies for managing angina
* Process of informed consent specific to older adults with CAD
* Risk stratification of older adults with CAD.

–Enumerate at least three unmet needs in the area that are ripe for multicenter collaboration.